ghid de evaluare preoperatorie a riscului hemoragic - ati | anestezie ...
ghid de evaluare preoperatorie a riscului hemoragic - ati | anestezie ...
ghid de evaluare preoperatorie a riscului hemoragic - ati | anestezie ...
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Evenimente <strong>hemoragic</strong>e<br />
Aprecierea competenþei hemost<strong>ati</strong>ce a pacientului (modificat) (5)<br />
A. Antece<strong>de</strong>nte personale medicale<br />
1. Evenimente <strong>hemoragic</strong>e non-chirugicale<br />
- menoragie<br />
- gingivoragie<br />
- VkQJHUDUH SUHOXQJLW GXS OH]LXQH PLQLP FXWDQDW<br />
- epistaxis bilateral<br />
- U QL vQ DEVHQ a traum<strong>ati</strong>smelor<br />
- KHPDWRP GXS LQMHF LH LQWUDPXVFXODU<br />
- KHPDUWUR] vQ DEVHQ a unui traum<strong>ati</strong>sm<br />
2. Evenimente <strong>hemoragic</strong>e perioperatorii, FX SUHFL]DUHD PRPHQWXOXL DSDUL iei (imediat postoperator sau<br />
tardiv)<br />
- subiective - skQJHUDUHD DQRUPDO GXS R LQWHUYHQ ie mLQRU DPLJGDOHFWRPLH H[WUDF LH GHQWDU ,<br />
a<strong>de</strong>nectomie)<br />
- obiective: - UHLQWHUYHQ LH vn scop hemost<strong>ati</strong>c<br />
- formare <strong>de</strong> hematom cu necesitatea drenajului<br />
- transfuzie<br />
%ROL FDUH VH vQVR HVF GH WXOEXU ri ale hemostazei<br />
- boli hep<strong>ati</strong>ce<br />
- boli renale<br />
- boli hematologice<br />
- boli digestivH PDOQXWUL LH PDODEVRUE ie)<br />
- boli imune<br />
B. Antece<strong>de</strong>nte heredo-FRODWHUDOH DFHOHDúi evenimente ca mai sus)<br />
C. Medicamente administrate în ultimele 10 zile<br />
- DVSLULQ<br />
- ticlopidin<br />
- clopidogrel<br />
- anticoagulante orale<br />
- KHSDULQ nonfrac ionat<br />
- heparin cu greutate molecular mic<br />
- alte anticoagulante<br />
- antiinflamatorii nonsteroidiene<br />
- antibiotice (<strong>de</strong>numirea)<br />
- DOWH PHGLFDPHQWH FDUH LQWHUIHU hemostaza<br />
Scor <strong>de</strong> apreciere a <strong>riscului</strong> <strong>de</strong> sângerare pe baza anamnezei ºi examenului clinic (5)<br />
Actualitãþi în <strong>anestezie</strong>, terapie intensivã ºi medicinã <strong>de</strong> urgenþã<br />
Tabelul 2.<br />
Tipul A<br />
1. Sângerare caUH GXUHD] PDL PXOW GH GH RUH VDX QHFHVLWDWHD WUDQVIX]LHL GXS R LQWHUYHQ LH FKLUXUJLFDO PLQRU<br />
(amigdalectomie, a<strong>de</strong>nectomie, circumcizie)<br />
6kQJHUDUH SUHOXQJLW GXS R H[WUDF LH GHQWDU VDX RULFH WUDWDPHQW GHQWDU VDX UHDSDUL LD VkQJHU ULL GXS GH ore<br />
,QJHVWLD GH DVSLULQ VDX RULFH DOW PHGLFDPHQW DQWLLQIODPDWRU QRQVWHURLGLDQ vQ XOWLPHOH GH RUH<br />
/D H[DPHQXO IL]LF U QL SHWHúLL EROL KHSDWLFH VDX KHPDWRORJLFH PDOQXWUL LH PDODEVRUE LH DOFRROLVm<br />
Tipul B<br />
5. Antece<strong>de</strong>nte heredo-colaterale: întrHE ULOH GH PDL VXV<br />
5 QLUH IUHFYHQW I U R FDX] HYLGHQW<br />
1HFHVLWDWHD LQWHUYHQ LHL FKLUXUJLFDOH GH RSULUH D HSLVWD[LVXOXL<br />
6kQJHUDUH GH SHVWH PLQXWH GXS R SXQF LH YHQRDV<br />
%RODYXO úWLH F DUH R WHQGLQ OD VkQJHUDUH FUHVFXW<br />
'DWD DSDUL LHL<br />
Data întreruperii<br />
Tabelul 3.<br />
57
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